JustCare

Tag: Lawsuit

  • Hospital billing practices frequently leave people without medical care or in court

    Hospital billing practices frequently leave people without medical care or in court

    The Lown Institute reports that if you aren’t able to pay your hospital bills, you have a one in three chance of being sued. On top of that, some hospitals are refusing to allow you to schedule new appointments.

    Almost half of adults in the US find affording the cost of healthcare challenging. Forty percent of them have medical debt. And, many of those people in debt end up choosing to go without medical care or to leave the hospital against medical advice. Medical debt now totals somewhere between $81 to $140 billion.

    The Lown Institute is collecting information on each hospital’s billing and collection practices. People should know which hospitals to avoid. That said, many hospitals are struggling to survive. There’s no excuse for hospitals filing lawsuits against patients, but the hospital system is broken. And, there’s also no excuse for the government standing back and watching hospitals go bankrupt because insurers are not paying them, to the detriment of their constituents.

    The Leapfrog Group, Northwestern University Feinberg School of Medicine, and Johns Hopkins University School of Medicine published a recent analysis of some hospital billing and collection data in JAMA. Of the more than 2,000 hospitals studied, a third said that they bring lawsuits against patients for delayed or inadequate payment of their bills. Rural hospitals sue patients more frequently than urban and suburban ones.

    What’s equally appalling is that hospitals often do not provide patients with itemized bills within a month of services. And more than one in 20 hospitals surveyed had no representatives to help patients with billing questions or to look into billing errors or to set up a payment plan.

    What is to be done? Lown does not propose national health insurance, likely because it’s not on the table at the moment. It should be. That’s the only way to ensure health equity and end medical debt. It’s also a far better way to ensure hospital solvency than allowing hospitals to sue patients for money they don’t have.

    Lown is focused on better hospital billing practices. Insanity. Who could step in to ensure that hospitals did a better job of billing patients? The JAMA authors say that if we standardized hospital billing practices, there would be greater accountability. Good luck! At the very least, we should be standardizing hospital prices.

    We should not leave it to the states to fix this problem. They do not have the will, the skill, the money or the power to take this on. Yes, a couple of states have done a little on credit reporting of medical debt. That’s something, but not wildly enough. How many millions more people will suffer the indignity of not being able to get medical care or of not being able to afford medical care or of being sued for not being able to pay medical bills before Congress acts?

    Lown Institute suggests that documenting the problem could help promote health care affordability and hospital accountability. By the time they have the data they need and anyone’s attention, tens of millions of Americans will have been harmed by our travesty of a healthcare system.

    Here’s more from Just Care:

  • Avoid a lawsuit, don’t sign nursing home admissions form

    Avoid a lawsuit, don’t sign nursing home admissions form

    Noam Levey reports for Kaiser Health News on nursing homes that sue the friends or family of residents to collect debt. And, it appears not to matter whether the friend or family has power of attorney or control of the patient’s assets. What usually matters is that a friend or family member signed the nursing home admissions form for the patient.

    Searching through Rochester, New York court records, Levey found 238 instances in which 24 nursing homes sued patients, relatives or neighbors in order to try to collect on a patient’s debt, in a three-year period. More than 70 of those cases were targeted at someone other than the patient or the spouse, who often did not have power of attorney over the patient. In one case, the sister of a nursing home resident was sued for $8,000 by the nursing home, even though she had no control over his health or finances and no legal responsibility for his debts.

    Levey found 60 cases in which the local government sued to collect nursing home debt over that same three-year period.

    Federal law should protect people from these lawsuits. Nursing homes are not allowed to force patients’ friends and families to guarantee their bills. But, the fine print in the nursing homes’ admission agreements often include something that a relative or friend signs, unwittingly, giving the nursing home debt collection rights.

    In many lawsuits, the nursing home has no evidence that the person being sued should be responsible for the bill. But, the nursing homes win many of these cases via default judgments because the person they are suing ignores the suit or does not have the means to hire a lawyer to defend them.

    New York is not the only state where this is going on. Levey reports that lawyers in Kentucky, Massachusetts, Illinois and California suggest that it is not uncommon for a nursing home patient’s family or friends to be sued to collect debt in their states.

    A recent Kaiser Family Foundation poll found that around 14 percent of adults with medical debt report being threatened with arrest or a legal action. Five percent report being sued.

    Tip: If you help a family member or friend get admitted to a nursing home, do not sign any papers. Make sure that, if anyone signs, it is the patient who signs.

    Here’s more from Just Care:

  • Providence Health sued for failing to provide charity care to low-income patients

    Providence Health sued for failing to provide charity care to low-income patients

    No question that corporate health insurers are driving up health care spending. The higher their costs, the more money they make. Some hospitals are helping the insurers and hurting patients, with high charges, facility fees, and aggressive billing practices. MedPage Today reports on a lawsuit against Providence Health for failing to provide charity care to its low-income patients, as required by law.

    Washington State’s Attorney General alleges in a lawsuit that Providence Health violated its obligation to its neediest patients. Instead of providing them with charity care, as required by law, it is failing to tell them about its charity care policy. What’s worse, it is billing them for the full cost of their care, sending their accounts to collection agencies and pushing them into medical debt.

    It’s easy to appreciate that for-profit hospitals engage in aggressive billing practices. But, Providence Health, which operates 14 hospitals in Washington State and is the state’s largest hospital system, is a non-profit. In just two years’ time, Providence sent the accounts of 46,783 patients with incomes between 151 and 200 percent of the federal poverty level to collection agencies.

    Washington State requires all hospitals to do what they can–“make a reasonable effort”– to ensure that eligible patients learn about the charity care they offer. They are not supposed to send their accounts to collection before they have made this effort.

    Instead, Providence Health has its representatives lead patients to believe that they must pay their bills, notwithstanding their income level. Staff are told not to back down when patients report that they cannot pay their bills. Staff are supposed to ask for half upfront and then work out a payment plan with patients.

    The suit claims that Providence sends many bills to collection with full knowledge that patients are low-income and cannot pay the bills. Whatever money it can extract, it wants. It appears that McKinsey & Company, a management consulting firm, helped Providence come up with the plan to avoid screening patients for charity care. Providence provided staff with scripts to use with patients that hid the availability of charity care from them.

    That makes it a lot easier for Providence to talk the talk–claim that it offers free care to patients with incomes under 300 percent of the federal poverty level–without walking the walk.

    Staff charged with collecting on hospital bills must reach specified targets and are assessed publicly. Not surprisingly, the lawsuit alleges that Providence Health does not make patients aware of its charity care policy when they are admitted, on discharge, or after patients explain that they cannot afford to pay for their care.

    Here’s more from Just Care:

  • Kaiser Permanente sued for misleading people about their network doctors

    Kaiser Permanente sued for misleading people about their network doctors

    The city of San Diego, California is suing Centene, Kaiser Permanente and Molina, three large corporate health plans, for false advertising about the health care providers in their networks reports Health Care Dive. Like many corporate health plans, they are deceiving potential members and cannot be trusted regarding the coverage they provide.  

    If you have traditional Medicare, you have a wide choice of doctors. With commercial insurance, be it through a Medicare Advantage plan, a state health care exchange, or your employer, your choice of doctors and hospitals can be quite limited. If you develop a costly condition, you might not be able to see the doctors you want to see.

    You can’t trust your health plan’s provider directory to reflect accurately the doctors you can use or the locations at which you can get care. Doctors come and go. If the doctors are in your health plan, they may not be taking new patients from your health plan. Or, you may only have coverage from in-network doctors at a location that is inconvenient for you, which is different from the location listed in the provider directory.

    People in corporate health plans, who do not have easy access to the doctors they need to see, too often forgo needed care. They endanger their health and well-being. What ‘s worse is that government has little ability to ensure that corporate health plans provide adequate access to care.

    In its lawsuit against Kaiser Permanente, Molina, and Centene, the city of San Diego argues that “ghost networks,” health plan networks that are misleading and improperly include out-of-network providers, threaten the public health. But, what leverage does it have to correct this issue even if it wins the lawsuit? 

    To address problems with health plan provider directories and help people make better decisions about their health plans, CMS imposed rules on health plans that became effective in 2016. Both Medicare Advantage plans and plans in the state health exchanges must publish up-to-date provider directories, including which doctors are seeing new patients, their locations, contact information, specialties and hospital affiliations. And, in addition to making them easily accessible, they must keep them updated each month.

    CMS can impose penalties on Medicare Advantage plans up to $25,000 per person enrolled if they violate the rules and up to $100 per enrollee on health plans in the state exchanges. These penalties should deter plans from listing doctors in their directories who have left their plans as much as ten years back, as some have been doing, but CMS has not. The Trump Administration chose not to fine Medicare Advantage plans that violate these rules.

    To help ensure a health plan’s in-network doctors meet your needs, talk to your doctors’ staff to see which health plan networks your doctors are in. Always call your health plan to double check. And, make sure that whatever plan you join has a stable of good specialists. Even if you’re healthy, you want to know that there are doctors in the plan who will meet your needs if you develop a costly or complex condition.

    Here’s more from Just Care:

  • Coronavirus: Hospitals sue patients and profit handsomely

    Coronavirus: Hospitals sue patients and profit handsomely

    I wish I could say that the COVID-19 pandemic has motivated Congress to take on high health care costs and predatory health care corporations. It has not. Instead, Vox reports that  Community Health Systems, a large national hospital system, has been profiting wildly while suing patients for unpaid bills.

    According to Vox, throughout the pandemic, Community Health Systems, based in Tennessee, and Northwell Health, a hospital chain based in New York, have been going after patients with unpaid medical bills. A New York Times expose led Northwell to end this bad behavior. Many hospitals and state governments have banned lawsuits for unpaid medical bills during the pandemic.

    With Community Health Systems, we are not talking a few hundred lawsuits. Community Health Systems has filed 19,000 lawsuits since March 2020. Meanwhile, its executives were rewarded handsomely, with multi-million dollar salaries and bonuses. The health system is flourishing, earning $511 million in profits in 2020. It received $705 million from the CARES Act in addition to state aid.

    Trinitas Hospital, a nonprofit based in New Jersey reaped $2oo million in profits in 2020. It filed more than 12 lawsuits.

    Our health care system need not and should not continue this way. Congress must make health care free. No one should be choosing between their health care and their rent. And, no health care stakeholder should be allowed, let alone have reason, to bring a lawsuit against a patient for necessary care provided. We need Medicare for All.

    Vox notes that the University of Virginia Medical System is working towards ending these pernicious practices. It is canceling unpaid bills it has accrued since the 1990s. Way to go UVA!

    Here’s more from Just Care: